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WASHINGTON — Two Marks from North Carolina have emerged as some of the key figures in the negotiations on how to repeal and replace the Affordable Care Act: Rep. Mark Meadows, chairman of the rebellious House Freedom Caucus, and Rep. Mark Walker, chairman of the more conciliatory Republican Study Group. Both have used the weight of the groups they lead to make the bill more palatable to conservatives, but they have different techniques to get it done.

President Trump may have been speaking in front of all House Republicans on Tuesday, but at one point during a closed-door meeting, the message was aimed directly at Meadows.

“I’m gonna come after you, but I know I won’t have to, because I know you’ll vote ‘yes,’” Trump said, according to Rep. Mark Sanford, R-S.C., who was inside the room.

Meadows, who represents the far Western point of the Tar Heel State, is head of the House Freedom Caucus, a group of about three dozen hardline conservatives who aren’t afraid to buck party leadership and who generally believe the bill does not go far enough in repealing the Affordable Care Act. Meadows has said that enough of his members will vote “no” on the repeal bill that it won’t pass the House. If the bill fails to move forward, it would be a major blow to both House Speaker Paul Ryan, R-Wis., and the president.

"I'm confident that we still have enough concerns that a vote of 216 votes in the House would not happen today,” Meadows told reporters late Monday night after a Freedom Caucus meeting, with 216 being the number of votes it will take to pass the bill in the House. On Tuesday after the meeting with Trump, Meadows told USA TODAY he still had concerns.

“This is a defining moment for our nation, but it’s also a defining moment for the Freedom Caucus. And so, when we look at that I don’t think there’s a more critical vote for the Freedom Caucus than this,” Meadows said.

But some of the Freedom Caucus' asks — including allowing insurance companies to sell across state lines – are difficult for House Leadership to produce because complicated Congressional rules require that everything in the bill must be related to the budget. Leadership has said there will be separate legislation later on to address these issues, that will not be burdened by the same Senate restrictions.

There's also the issue of getting the legislation through the more moderate Senate where the GOP enjoys only 52-48 majority and can't lose more than two votes. The further to the right conservatives pull the legislation in the House, the more difficult it will be to make it through the Senate.

If Meadows is the face of the group threatening to withhold votes in the hopes that the bill will be sent back to the drawing board, it’s the other Mark from North Carolina who has worked behind the scenes to move the legislation to the right and round up Republican votes for it.

Walker, representing the the north-central portion of North Carolina along the Virginia border, chairs the Republican Study Committee, which is the other major conservative bloc within the House. The RSC is a far larger and more established group than the Freedom Caucus — it’s been around since 1973 and has more than 150 members. Previous chairmen include Vice President Pence, Health and Human Services Secretary Tom Price and House Majority Whip Steve Scalise, R-La.

Walker also started out as a “no” on the legislation but changed to a “yes” after a meeting with Trump last week, along with a group of other conservative lawmakers. Trump endorsed some conservative changes to the bill — a work requirement for able-bodied Medicaid recipients, the option to provide block grants to states and some anti-abortion assurances — and Walker got on board. Those changes appeared in an amendment House leaders circulated Monday night.

“Working alongside RSC members, we advocated and achieved important conservative policy changes to the bill. While we have moved it in the right direction, we hope the bill will continue to improve through the legislative process,” Walker said Tuesday.

Rep. Jim Banks, R-Ind., is the freshman representative of the RSC's steering committee and was at the meeting with Trump last week. The Freedom Caucus' political arm ran ads for him
during the election, but he ultimately decided not to join the Freedom Caucus once he got to Congress so he could focus on his role at the RSC.

“The RSC has been very constructive, we set out many weeks ago to develop a menu of several conservative ideas that we could advocate for within the bill and once the bill was released some changes," Banks told USA TODAY. "Those were the changes that we took to the president on Friday in the Oval Office which he readily accepted and vowed to endorse and support."

He said perhaps the Freedom Caucus is trying the same approach, meeting with Trump Wednesday, “a meeting that sounds a lot like the meeting that the RSC leadership had with the president."

President Trump listens as Rep. Mark Walker, R-N.C. speaks during a meeting with the Republican Study Committee on March 17, 2017, in the Oval Office.(Photo: Evan Vucci, AP)

“Circumstances have brought both Marks to greater prominence than before. (Health care) is an issue that is difficult for Republicans and they’re playing a significant role now that the measure is moving to the floor,” said John Pitney Jr., a professor at government at Claremont McKenna College. “Mark Walker is the right-wing and Mark Meadows is the righter-wing — there is no left wing.”

“Walker’s activities are actually fairly standard in congressional negotiations: you hold out and you get some concessions,” said Pitney, who has worked for Republicans in the House and Senate, including former vice president Dick Cheney when he was in Congress.

“The role of the RSC continues to grow as one in the conference" with the goal being "effective conservatism,” Walker said during an interview in his office earlier this month. “One that is getting things done, that is standing up for conservative values but doing so in the right tone, the right spirit. You’re not going to hear us calling Speaker Ryan a liar or using terms or terminology like that.”

To be clear, Meadows has never called Ryan a liar, but the Freedom Caucus has been highly critical of the way Ryan and House leadership have handled negotiations on the repeal bill. They group was also instrumental in forcing the resignation of House Speaker John Boehner in 2015 because they were unhappy with compromises he was making with President Obama.

“We feel like there’s a high road in all this that you can accomplish what you want to do without compromising your values or principles,” Walker continued. “It doesn’t mean that we’re not going to pushback, as you’ve seen recently, but I believe there’s a way to do that that ultimately gets you to your goal in a more productive manner than it does taking more of a negative tone.”

Alice Stewart was the communications director for Texas Sen. Ted Cruz’s presidential campaign and works as a Republican communications consultant. She agrees with the Freedom Caucus that the repeal and replace legislation should be more conservative and praised Meadows' negotiation tactics.

“He wants to get it right and it doesn’t have to be right now. He is doing the heavy lifting, the unnecessary sausage-making to get a successful piece of legislation on the table,” Stewart said. “He knows full well the power in numbers and the strength of the Freedom Caucus can make or break this health care legislation.”

But she also had praise for Walker’s ability to get some conservative tweaks in the new amendment.

“Any piece of progress in that direction is progress and I commend him for moving that ball down the field,” Stewart said.

Ohio Rep. Jim Jordan has been chair of both the RSC and the Freedom Caucus; these days he sits on the RSC’s steering committee and the Freedom Caucus board.

“Probably the biggest difference is one group is much larger than the other so there’s different dynamics when you’re dealing with a group of you know 30-something members or 160 or whatever it is,” Jordan told USA TODAY on Tuesday. “Both are wonderful individuals, both solid individuals with a Christian perspective and the right kind of values and the right kind of principles.”